How to find an Ethical & Skilled Therapist
This is a Harm Reduction Document.
It does not replace medical or therapeutic advice. You acknowledge that you alone are responsible for doing your due diligence if you are to read beyond this disclaimer.
This is a living document and may change as community input is integrated. Please feel free to comment.
Finding an ethical and skilled psychedelic guide checklist
- This questionnaire is for individual sessions.
Additional questions to ask for group sessions are not addressed here.
For the purpose of this document the use of the word, ‘guide’ will be used to include all psychedelic space holders including therapists, psychotherapists, psychologists, clinical counselors, sitters and shamans etc.
Considerations and questions to ask before deciding to work with a guide
- Are they aware of the MAPS Code of Ethics?
- Are they aware of the North Star Pledge?
- How do you feel around them?
Even a sitter with a lot of experience and a great reputation may not be a good match FOR YOU. Tune into your body and notice if there’s a sense of relaxation and openness or are you feeling some ambivalence and tension? Don’t base your decision solely on a sitter’s credentials or reputation.
- What is their personal experience in working with this medicine?
A sitter must have experience with the medicine you will be using in order to understand the terrain that you will be navigating. I.e. You wouldn’t hire a guide to take you to the summit of Mt. Everest if they had never been there themselves.
- What is their therapeutic background?
Although formal training does not necessarily mean that they will be a good psychedelic guide, and there are many excellent guides with no formal therapeutic background, it does give you some idea of what kind of experience they’ve had in working with people in vulnerable and non-ordinary states of consciousness.
- Do they have any formal or informal training in working with psychedelics?
Outside of clinical trials, there has been very little formal training offered in working with psychedelics due to the legality of the substances. Most trainings offered have been underground although that’s rapidly changing. Check their reputations by asking around and doing your own research.
- Approximately how many ceremonies/treatments have they facilitated?
Psychedelic therapy is very nuanced work that can only be learned by experience.
- Do they have a co-therapist/guide or do they work alone?
Whenever possible, having two guides is preferred for the comfort, safety and accountability of all involved. If they work alone will they allow you to bring in a trusted friend as the second sitter? Most sexual interference that we hear about is between a male therapist and a female client although there have been cases with a female therapist and male client. There has also been a high profile case with a married (male, female) couple. Ask your therapist if they will agree that no sexual touch or innuendo will happen either before, during or after the session.
- Have they done a comprehensive intake of your physical and psychological well-being to assess if you’re a good candidate for this session?
There are definite contraindications for certain mental health and physical conditions as well as medications.
- Ask the guide how they see their role in preparing for the session, facilitating the session and integration of the session.
- How do they see the role of the ‘inner healer/wisdom’?
It’s your own inner healer/wisdom that will navigate your experience and guide you where you need to go. The guide’s role is to gently support and encourage you to contact your inner healer/wisdom and to create an environment of complete safety in which you will be supported in a non-judgemental, unconditionally loving, and accepting way during your entire journey.
- What is their plan in the case of a physical, emotional or spiritual emergency?
- What style or approach do they offer i.e. psychotherapeutic, psycho-spiritual, shamanic, somatic?
- What other modalities do they use in their sessions i.e. energy work, breathwork, somatic?
Ask them specifically and ensure you are comfortable with the modalities they use. Ask as many questions as is necessary for you to fully understand.
- What setting will the session take place in?
- Would they agree to arrange for you to talk to one of their previous clients?
- Are they part of a peer support group?
Are you invited to contact members of the peer group for a testament to their character and skill as a guide?
- Do they make an audio recording of the session for your use afterwards? For what purposes, who has access to it, how is it stored afterwards and for how long?
- If you raise concerns, issues, or fears, how does the guide handle them? If your concerns are dismissed or minimized, this could be a red flag.
- Have they talked to you about intention setting and the reason you want to have a psychedelic or non-ordinary state of consciousness session?
- Do they use any kind of ceremony/ritual in their session?
Many guides and sitters begin and end the session with a ceremony or ritual. If this is not in alignment with your religious or cultural beliefs let them know. If you’re not comfortable with the ceremony/ritual being offered, will they work with you to create a ceremony better suited to you? You can also ask that there be no ceremony or ritual if that’s your preference.
- What are their views around the use of touch?
Are they trained in any somatic modalities? (See Red Flags below).
- Have you received your guide’s rules about leaving the space during a session?
- How long will they stay with you after the treatment/ceremony?
Your sitter should stay with you until you feel physically, mentally and emotionally ready to leave the space before venturing back into the world. You will be in a vulnerable state and the ‘outside world’ may feel harsh.
- Will your guide arrange a follow up call to check in within a reasonable window of time, e.g. 2-3 days?
It’s very helpful to touch base with your sitter within a day or two of the session. This is the beginning of the integration phase and a lot of emotions, memories and insights can come up. Checking in with your guide can help to ground the experience and give you confidence that all that you’re experiencing is a normal part of the process. If you’re having difficulty making sense of the experience they can also help you to learn ways of integrating what may be a new way of viewing the world.
- What kind of integration and after care is being offered?
If ongoing integration is not part of the arrangement you have made with your guide it’s highly recommended that you find someone to process your experience with. If you have limited financial resources it can be helpful to talk to a trusted friend or join an online integration group. Many of the psychedelic societies and associations around the globe offer integration groups which you can find on Facebook or Meetup or by Googling integration groups.
- Does the guide use medicine themselves during the session?
Some guides use micro or small doses of the same medicine as you as a way of tuning into you and the ‘energy of the medicine’. Many ethical lapses emerge when a sitter is on a high dose of medicine (vs micro-dose) and their boundaries are relaxed. The guide should be the sober one in the room!
- Definition of sober sitter.
Being able to attend to the client's physical and emotional needs without hesitation and with impeccable and appropriate care and integrity.
- What medicine and dose will be used?
There’s a wide variation in effective dose. Your sitter may suggest that you do a test run beforehand with a low dose to assess your tolerance to the medicine. i.e. 5 grams of Psilocybe cubensis may be the perfect dose for one person and another will need 2.5 or even 8 grams for a similar effect.
For more info on drug interactions here are some good resources:
Spirit Pharmacist https://www.spiritpharmacist.com/consultation
Third Wave https://thethirdwave.co/psychedelics/
- How do they record your information and protect your confidentiality?
Do you fully understand your guide’s commitment to confidentiality and any limits to it?
- I recognize that only regulated health care workers and lawyers can protect my confidentiality.
- What are they charging and what method of payment?
A bit about preparation
You’re about to engage in what may be one of the most fascinating, beautiful and transformative experiences of your life. You may also experience some emotionally and psychologically difficult moments as past traumas are recalled and integrated during and after your session. Please keep this in mind as you read through the many safety measures we’ve outlined that are designed to ensure that you have the most healing and positive experience possible.
A psychedelic journey can begin the moment you decide to do one, rather than the moment you ingest the medicine. By focusing your attention inward for a period of time each day leading up to the session, you can lay the foundation for the deep inner work you'll be doing.
This is the time to tune into the reason you are doing this session. What brought you to this decision in the first place? What do you hope to get out of it? Writing it down can be helpful in gaining clarity about your reasons and deepest longings.
Preparation includes eating well, getting plenty of rest and exercise, and most importantly, finding time to ‘do nothing’ and quiet your mind. This may mean walks in nature, meditation, yoga, journaling etc. Learning and practicing relaxation breathing exercises in advance can be very helpful in the event that you encounter difficult moments during your session.
Expectations and intentions
If you have a strongly held expectation of what will happen, you may miss the gifts of wisdom and healing that are actually being offered. Keeping an open and curious mind about what’s going to unfold will be of huge benefit.
As the Rolling Stones say, “you can’t always get what you want, but if you try sometimes you might find, you’ll get what you need”. This is very true for working with psychedelics.
And, as Deepak Chopra says, “relinquish your rigid attachment to a specific result and live in the wisdom of uncertainty. Intend for everything to work out as it should, then let go and allow opportunities and openings to come your way.”
Certain prescriptions (e.g. SSRIs) as well as herbals and supplements should not be combined with psychedelics. Please feel confident that your guide is aware of any contraindications and get a second opinion if you have any concerns.
For more info on drug interactions here are some good resources:
Trina Nguyen https://www.thedharmacist.com/
Spirit Pharmacy https://www.spiritpharmacist.com/consultation
Third Wave https://thethirdwave.co/psychedelics/
Other psychoactive substances
Your guide should ask you about other psychoactive substances you’re taking and let you know if they will adversely interact with the medicine you’ll be using in your session. If they haven’t, take it upon yourself to ask about it.
Red flags and some advice
Touch - sexual and other
- According to the Code of Ethics of the PAC and the members who have agreed to them, sexual touch with your guide should not happen before, during or after your psychedelic session.
In the therapy world, it’s unanimously agreed that there is an inherent power differential between the guide/therapist that can’t easily translate into a balanced, healthy dual relationship. Given the prior agreement that there will be no sexual touch, if this becomes difficult for either party to maintain, the guide should seek counsel from their peers and regulating bodies (if applicable) and the client should seek counsel with an independent licensed therapist to find ways of either maintaining this agreement or ending the therapeutic relationship.
There are some psychedelic ‘therapists’ who are offering what they call Erotic Medicine Journeys or calling themselves Sacred Whores/Prostitute/Gigilo etc. There have been several reports from their clients expressing how there wasn’t consent given to sexual touch beforehand which resulted in great harm to their mental well being. Sexual interference can also happen with speech and on an energetic level. What may feel right in the moment under the influence of medicine will inevitably turn into a very conflictual state.
Psychedelic psychotherapists have found that in order for the deepest healing from sexual trauma to occur, there must be a high level of trust with the therapist and this isn’t possible when there is sexual acting out.
There are trained sex therapists and sex surrogates who have received substantial training in this area. These ‘Sacred Prostitutes’ (et al) do not fall into that category. If you’re considering working with those who include sex practices in the session there should be a clear informed consent in advance around what this will include.
A discussion around the use of touch should happen prior to the session.
Non-sexual touch can be very helpful in the healing process if healthy and ethical boundaries can be maintained. This might include hand holding. If you have not consented to the use of touch it should not happen unless you are physically endangering yourself or others. Even if you have given prior consent, you can change your mind at any point during the session. The sitter should discuss with you in advance how you can convey a change of consent such as a hand gesture, using the word STOP, or any other method that you agree on.
Please also be aware that there are some therapists that do not offer any touch at all. This should also be discussed so that you can find a guide who is best for you.
- Ethical violations can be more than inappropriate touch. When a guide inserts themselves into your treatment in an energetic, physical, or spiritual way, it may violate your ‘safe container’ when you are most vulnerable. A good way to assess whether the guide is trying to take control of the session is by noticing if you are feeling more in touch with yourself or if you are more in tune with your sitter/guide/therapist. This should feel like your session NOT theirs.
- Be wary of guides who speak about how they can heal you. The guide’s role is to support the ‘inner healer/wisdom’ that these medicines allow us to get in touch with. The healing comes from within.
- Be wary of guides who appear to know it all or tell you what your experience will be. They may have an idea of the broad range of experiences that are possible but there is no way for them, or even you, to know what your experience will be in advance and each session can be vastly different. The guide and client should both enter into it with a sense of curiosity and openness. Find a guide who is humble and willing to learn from you.
- Ask your guide/sitter why they are suggesting a particular medicine for your session. If you’ve been looking forward to a Psilocybin session and your therapist wants to use MDMA instead you’ll want to understand why. The decision around which medicine is used should be made together with your guide/sitter.
The Psychedelic Explorer’s Guide - James Fadiman
Manual for Psychedelic Guides - Mark Haden
In the Realm of the Hungry Ghost - Gabor Mate, MD
Consciousness Medicine - Francois Bourzat*
Sacred Knowledge - William Richards
How to Change Your Mind - Michael Pollan
* We know there is controversy and we still feel this book is well written and a good resource.
Other - Harm Reduction
In deep gratitude to these powerful healing medicines and all those throughout history who have paved the path which has brought us here.
- Lorraine Percy & Pam Kryskow
ACKNOWLEDGEMENTS FOR THEIR CONTRIBUTIONS AND COMMENTS
Dr. Pamela Kryskow
Bruce Tobin, PhD
Acknowledgements for their contributions
Bradley Foster and Scott Kouri
Bruce Tobin PhD., Tricia Bowler, Derek Endress, Brendan Leier PhD. and Michael Oliver
Your assistance is welcome
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